ASAM An Overview - Magellan Health
ASAM – An overviewASAM History, Criteria, and Highlights of 2013 ChangesThird Thursday Provider CallJanuary 15, 2015
At the end of this presentationyou should be able to: Describe how ASAM was created and four important changes itbrought to/reflected in the Substance Related Disorder field. Name three crucial components of the 2013 ASAM Criteria that areNOT substantially changed from the 2001 ASAM PPC. Identify the six dimensions that are components of all substancerelated disorder assessments Specify the special populations the 2013 ASAM Criteria addresses Discuss the philosophy behind the shift from ‘Patient Placement’ tosimply ‘Criteria. Name the addictions added to both the DSM-5 and 2013 ASAM2Third Thursday Provider Call (1/15/15): ASAM – An overview
History:WHAT IS ASAM?ASAM – Stands for American Society of Addiction MedicineRoots of Criteria in mid-1980s Multidisciplinary groups with purpose of developing ‘national set of consensuscriteria’ Change from fixed addiction treatments toassessment-basedclinically drivenoutcomes-oriented continuum3Third Thursday Provider Call (1/15/15): ASAM – An overview
ASAM reflected important evolutionsin the field of Addiction Treatment: Multidimensional Assessment & Treatment:Change from focus on just substance abuse to biopsychosocial ‘Set program’ for all to Clinically driven treatmentIndividualized treatment Fixed program to Variable length treatmentExample: 28 Day Inpatient/Residential Very limited levels of care to broad ContinuumInpatient & IOP/AA to full spectrum of treatment settingsAll of these are ‘works in progress’ around the country4Third Thursday Provider Call (1/15/15): ASAM – An overview
History of ASAM Criteria1991: First edition of ASAM’s Patient Placement Criteria for the Treatment ofPsychoactive Substance Use Disorders1996: ASAM PPC-2 :Included Continuing Stay and Discharge Criteria1998/99 ASAM PPC endorsed by 30 states, Dept of Defense, & some MCOs2001: ASAM PPC-2RChange to Admission Criteria only(2010: ASAM Supplement)2013: The ASAM Criteria – Treatment Criteria for Addictive,Substance-Related, and Co-Occurring Conditions5Third Thursday Provider Call (1/15/15): ASAM – An overview
ASAM heralded a shift intreatment philosophy 6Shift from one size fits all to Individualized treatmentInclusion of psychosocial & societal factorsDischarge planning; Wrap around servicesGender & diversityConsideration of patientsatisfaction & outcomes; researchon treatment responseThird Thursday Provider Call (1/15/15): ASAM – An overview
What Stays the Same in the 2013ASAM Criteria Dimensions for Assessment Broad Levels of Service “Decision Rules” – Severity of Illness generallydetermines Intensity of Service7Third Thursday Provider Call (1/15/15): ASAM – An overview
Multi-dimensional Assessment1.Acute Intoxication &/or Withdrawal Potential2.Biomedical conditions & complications3.Emotional/Behavioral/Cognitive conditions & complications4.Readiness to change5.Relapse/Continued Use/Continued Problem potential6.Recovery Environment8Third Thursday Provider Call (1/15/15): ASAM – An overview
No Dimension 7?Spirituality? Spirituality is an ongoing conversation in theaddictions field Spiritual concepts - ideas & relationships very inimportant ways in recovery Addiction includes “spiritual manifestation” The bottom line:Spirituality difficult to define in objective, behavioral& measurable terms9Third Thursday Provider Call (1/15/15): ASAM – An overview
Applying the MultidimensionalAssessment for Decision Making ALL Dimensions to be assessed for ALL levels of treatment Weighting of dimensions varies for different levels oftreatmentExample:Medically-Managed Intensive Inpatient Services Dimensions 1 &2 primary Dimension 3 may also be important Dimensions 4-6 assessed, but not crucial to decision making10Third Thursday Provider Call (1/15/15): ASAM – An overview
Dimension 1:Acute Intoxication &/or WithdrawalPotential Assessment for intoxication and withdrawal management2013 ASAM:‘Withdrawal management’ replaces ‘Detoxification’Types of Substances used (withdrawal potential)Amount, frequency, length of use, last useHistory of serious withdrawallife threatening withdrawalseizures11Third Thursday Provider Call (1/15/15): ASAM – An overview
Dimension 2:Biomedical conditions & complicationsBiomedical Conditions Current Physical illnesses? Managed or unmanaged? Contribute or complicate treatment? Chronic conditions – impact treatment?12Third Thursday Provider Call (1/15/15): ASAM – An overview
Dimension 3:Emotional/Behavioral/Cognitive conditions& complicationsEmotional/Behavioral/Cognitive conditions & complications Psychiatric disorders? Diagnosed or undiagnosed?Commonly co-occurring psychiatric diagnoses Psychological/emotional/cognitive problems that need tobe addressed? Chronic disorders? (schizophrenia, personality disorder) Grief and loss issues? Ongoing assessment essential to differentiating betweenco-occurring mental health disorders and substanceinduced disorders13Third Thursday Provider Call (1/15/15): ASAM – An overview
Dimension 4:Readiness to changeStages of ChangeMotivational Interviewing (Miller & Rollnick)Not readyUnsureReadyTryingDoes he/she feel coerced? (Many forms of coercion; not just legal)Compliant? Internally distressed? Avoiding negative consequences?At different readiness stages for SA vs MH issues?14Third Thursday Provider Call (1/15/15): ASAM – An overview
Dimension 5:Relapse/Continued Use/Continued ProblempotentialRelapse/Continued Use/Continued Problem potential Immediate danger of continued distress and/orabuse? Awareness and specificity of triggers & personalrelapse dangers? Recognition of relapse prevention skills/coping?Development of skills?15Third Thursday Provider Call (1/15/15): ASAM – An overview
Dimension 6:Recovery EnvironmentRecovery EnvironmentDangerous? family/significant other Living situation/Community Work/school situationthat threaten treatment engagement & successSupports? Family/friends/community Financial Educational/vocational16Third Thursday Provider Call (1/15/15): ASAM – An overview
Continues in 2013 ASAM:Treatment Levels of ServiceLevels of Service1. Outpatient Treatment2. Intensive Outpatient and Partial Hospitalization3. Residential/Inpatient Treatment4. Medically-Managed Intensive Inpatient TreatmentExpansion and some changes within broad levels of service17Third Thursday Provider Call (1/15/15): ASAM – An overview
What’s New in 2013 ASAMThe Title:The ASAM Criteria – Treatment Criteria forAddictive, Substance-Related, and Co-OccurringConditions No longer ‘Placement’ criteriaEmphasis on chronicity and treatment18Third Thursday Provider Call (1/15/15): ASAM – An overview
New in 2013 ASAMExpanded definition: ‘Addiction’ replaces all previous terms Focus still on forms of ‘chemical dependency’ ASAM’s mission is not ‘behavioral addictions’ ’primary, chronic disease’ ‘biological, psychological, social and spiritualmanifestations’ “The pathological pursuit of reward or relief bysubstance use and other behaviors” ‘chronic disease’ ‘cycles of relapse and remission’ 19Third Thursday Provider Call (1/15/15): ASAM – An overview
New in 2013 ASAM:Withdrawal Management ‘Withdrawal Management’ supersedes ‘Detoxification’:Levels WM-1, WM-2, WM-3 (3.2, 3.7) and WM-4 Increased support for less intensive levels of care for safe management ofwithdrawal Risk Rating Assessment Format – severity, LOF, service needs to determinetreatment plan and level of care Inclusion of Withdrawal Management Instruments AppendixCOWSo CINAo CIWAoEmphasizes withdrawal management as not high level of care one-and-done,but a continuum of support.20Third Thursday Provider Call (1/15/15): ASAM – An overview
New in 2013 ASAMLevel of Care descriptors More levels of care within each of the broad levels Changes from Roman numerals to Arabic numerals, e.g.: “Level I” becomes “Level 1” “Level II.1” becomes “Level 2.1” “Level II.5” becomes “Level 2.5” ASAM Level 3.3 is now ‘Clinically Managed Population-Specific HighIntensity Residential Services ‘o21Less intensive milieu/group for those with cognitive or other impairmentsunable to benefit from a full milieu environmentThird Thursday Provider Call (1/15/15): ASAM – An overview
New in 2013 ASAM:“Complexity Capability” Co-occurring Mental health assessment andtreatment Primary care coordination and treatment‒ Co-occurring Infectiousdiseases Trauma Informed22Third Thursday Provider Call (1/15/15): ASAM – An overview
New in ASAM 2013:Special PopulationsSpecific Population Chapters & Criteria for Older Adults Parents with Children/Pregnant women Safety Sensitive Occupations Criminal Justice settings23Third Thursday Provider Call (1/15/15): ASAM – An overview
New in 2013 ASAM:Expansion of Outpatient Philosophy Not just ‘gateway’ or ‘aftercare’ Ongoing disease management for maintenance Parallels drawn to diabetes, asthma, hypertension Some may need for life – not a failure24Third Thursday Provider Call (1/15/15): ASAM – An overview
New in ASAM 2013:Updated Diagnostic CriteriaDiagnostic Criteria Updated to be compatible withDSM-5o Shift from ‘categories’ to Continuumo Inclusion of Gambling Disorder section Tobacco Use Disorder chapter25Third Thursday Provider Call (1/15/15): ASAM – An overview
New in ASAM 2013:Update on Opioid Treatment Services Expanded beyond Opioid TreatmentPrograms (methadone) Inclusion of MAT OBOT26Third Thursday Provider Call (1/15/15): ASAM – An overview
2013 ASAM SummaryContinued and Expanded: Multidimensional Assessmentutilizing the 6 Dimensions Broad Levels of Care Decision making Expands and emphasizesintegration of substance relatedand mental health27Third Thursday Provider Call (1/15/15): ASAM – An overviewNew in 2013 ASAM: ‘Criteria’ to emphasize ongoingassessment and continuum; no longer‘patient placement’ Terminology and, by inference,philosophical emphasis Compatible with DSM-5 – Arabicnumerals, diagnoses, inclusion ofgambling & tobacco Special Populations specificallyaddressed: Older Adults,Parents/pregnant women, SafetySensitive Occupations, & Criminal justicesettings Expansion/partial redefinition ofWithdrawal Management, Outpatient,Opioid treatment and ‘ComplexityCapability’
References Miller, Michael M. “What’s New in the ASAM Criteria.” NAATP AnnualConference, San Antonio, TX. 20 May 2013. Mee-Lee, David. “What’s New and How to Use the ASAM Criteria: SkillBuilding in Implementing the New Edition.” ICADD, Boise, ID 12 May2014. American Society of Addiction Medicine, http://www.asam.org The Change Companies, https://www.changecompanies.net28Third Thursday Provider Call (1/15/15): ASAM – An overview
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Questions & Answers30Third Thursday Provider Call (1/15/15): ASAM – An overview
History of ASAM Criteria 1991: First edition of ASAM’s Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders 1996: ASAM PPC-2 : Included Continuing Stay and Discharge Criteria 1998/99 ASAM PPC endorsed by 30 states, Dept of Defense, & some MCOs 2001: ASAM
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American Society of Addiction Medicine, Third Edition, 2013 The Change Companies, Publisher To help you learn more about ASAM . Illustrate the important role of ASAM in the changing world of behavioral health care Define and review the ASAM Criteria Connect the ASAM with othe
and ASAM. The ASAM Resource User Guide. Intake/Assessment. Intervention/Treatment Outcomes. The information provided here will help you best implement ASAM’s criteria. The products and services offered under the collaborative partnership of ASAM and The Change Companies provide treatment teams and clinicians with support throughout the .
ASAM Criteria must require more staff, expense, and administration to provide all the levels ASAM Criteria is a medical model and requires everyone to hire a medical director ASAM Criteria is biased to advocate for more inpatient treatment ASAM Criteria is biased to advocate for more outpatient treatmentFile Size: 556KB
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